Is Biologic Medicine For Real?

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Is Biologic Medicine For Real?

There comes a time when this body we have always taken for granted suddenly insists on being noticed. I used to think that stretching before running was for suckers, that my muscles didn't need a warm-up. Now I know better. I used to assume my joints were frictionless hinges. Now I feel the friction - my left knee aches after a game of basketball. Sure, I'm a wimp and complainer, but there's a certain inevitability to such laments. To borrow a metaphor from W.H. Auden: the human body is a bit like limestone. It seems so tough and permanent, but we must never forget that it's actually fragile and fleeting, a machine made of temporary parts. If limestone dissolves in water, then our body dissolves with time.

That's a windy windup for my latest article in Grantland on a potentially interesting breakthrough in sports medicine known as biologics. I begin the piece not with a pretentious reference to my aching knee, but by looking at the resurgence of Kobe Bryant.

By nearly every metric, Kobe Bryant is having his best season in years. Not only is he leading the league in scoring, but he's also performing above his career average in points per game and rebounds. (As always, Kobe is shooting too much: plus ça change.) Even his minutes are up: Kobe is playing nearly five minutes more per game than last season.

This is not the usual curve of an NBA career. As the economist David Berri has demonstrated, most NBA players exhibit an inverted U curve of productivity, showing a steep ascent as they first learn to play in the NBA. Their peak arrives shortly thereafter, usually around age 24 or 25, and is followed by a steady plateau until age 27. It's at this point that the decline begins: The grind of the season starts to dismantle the body. Joints give out, muscles lose their fast twitch fibers, tendons are torn. It's the usual tragedy of time, only accelerated by the intensity of professional basketball. By the age of 30, their glory days are probably long gone.

And yet, the aging Kobe — he will turn 34 this summer1 — seems to have resisted this dismal downward arc. In particular, Kobe's arthritic right knee seems to have healed itself, allowing him to return to more aggressive form. As Mike Brown, the Lakers coach, noted in December: "He's done some things in practice that have kind of wowed you as far as taking the ball to the basket strong and finishing with dunks in traffic." Kobe concurs: "I feel a lot stronger and a lot quicker."

Although Kobe has been mostly silent on the topic of his arthritic knee — "I'm not talking about my injury" is a constant refrain — his main treatment consisted of a new therapy called Regenokine. The therapy itself is part of a larger category of treatments known as "biologic medicine," in which the patient's own tissues are extracted, carefully manipulated, and then reintroduced to the body.

In recent years, there has been an explosion of interest in biologics. (The list of people who have also experimented with Regenokine reportedly includes Fred Couples, superagent Ari Emanuel, and the late Pope John Paul II.) Those willing to pay out of pocket can now treat their ailing joints with everything from platelet rich plasma (PRP) therapy, in which blood is spun until it contains a high concentration of healing platelets, to concentrated bone marrow injections, dense with stem cells. What all of these biologics have in common is the same appealing logic: Instead of cutting with a scalpel, or administering a synthetic drug — these treatments have long recovery times and nasty side effects — the healing mechanisms of the flesh should be put to work. The body heals best when it heals itself.

Consider the Regenokine approach, a patented method developed by Dr. Peter Wehling, a spinal surgeon in Düsseldorf, Germany. The procedure begins with the removal of a small cup of blood from a patient, which is then incubated at a slightly elevated temperature. (The goal is to give the blood a fever.) The liquid is then spun in a centrifuge until it's separated into its constituent parts. The heavy red blood cells accumulate in the bottom layer, a layer of crimson crud at the bottom of the plastic tube. The relevant fluid is the middle yellowish layer — it looks like viscous urine — which is dense with agents that, at least in theory, can accelerate the natural healing mechanisms of the body. "The inflammatory response is normally part of the recovery process," says Chris Renna, one of the only American doctors administering Regenokine. "But sometimes the body can't turn the inflammation off, and that's when you get chronic pain and arthritic degeneration. The goal of Regenokine is to stop that response so your body can begin getting better."

Kobe is clearly a believer in Regenokine and biologic medicine. Last July, he traveled to Düsseldorf, Germany, for an experimental version of the treatment and, according to reports, returned for a second round in October. He even recommended the treatment to Alex Rodriguez, which led the baseball star to undergo the same treatment on his knee late last year. Bryant hasn't commented publicly on the treatment, but A-Rod has described the feelings of his friend. Bryant "was really adamant about how great the procedure was for him," Rodriguez told reporters."I know that he was hurting before, almost even thinking about retirement, that's how much pain he was under. And then he said after he went to Germany he felt like a 27-year-old again. I was still a little apprehensive about it and he kept staying on me about it."

The reason Kobe, A-Rod, and other athletes travel to Germany for their biologic treatments involves a vague FDA regulation that mandates that all human tissues (such as blood and bone marrow) can only be "minimally manipulated," or else they are classified as a drug and subject to much stricter governmental regulations. The problem, of course, is figuring out what "minimal" means in the context of biologics. Can the blood be heated to a higher temperature, as with Regenokine? Spun in a centrifuge? Can certain proteins be filtered out?2 Nobody knows the answer to these questions, and most American doctors are unwilling to risk the ire of regulators.

The lack of clear FDA approval also reflects the larger uncertainty over biologic medicine. After all, many of these procedures are only a few years old, which means there is scant proof of their effectiveness. As a result, the case reports of athletes represent an interesting test of the medicine. Their performance on the field is a kind of clinical trial.

If Kobe and these proponents of biologic medicine are right, it will represent a stunning advance in sports medicine. While most athletes have been forced to undergo surgery after suffering joint damage — Kobe has undergone several procedures himself, with mixed results — biologic therapy holds out the enthralling possibility that these injuries can be reversed. Furthermore, such therapies are typically done on an outpatient basis, with recovery times measured in days, not months.

The alternative, of course, is that Regenokine, PRP therapy and stem cell injections are merely the latest overhyped medical treatments for desperate athletes, risky procedures that have yet to be properly vetted by rigorous clinical trials. Given the paucity of evidence, it's entirely possible that these biologic treatments will one day be consigned to the trash bin of experimental medicine, a set of therapies that are little more than an expensive placebo. Perhaps Kobe's knee isn't really healed — he just thinks it is.